《减重手术后患者应用胰高血糖素样肽-1 受体激动剂：系统评价和荟萃分析》
Glucagon-Like Peptide-1 Receptor Agonists in Post-bariatric Surgery Patients: A Systematic Review and Meta-analysis.
机构信息
Department of Endocrinology, Center for Endocrinology Diabetes Arthritis & Rheumatism (CEDAR) Superspeciality Healthcare, Dwarka, New Delhi, India.
Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, India.
出版信息
Obes Surg. 2024 May;34(5):1653-1664. doi: 10.1007/s11695-024-07175-8. Epub 2024 Mar 19.
BACKGROUND
A significant number of patients face the issue of weight gain (WG) or inadequate weight loss (IWL) post-bariatric surgery for obesity. Several studies have been published evaluating the role of glucagon-like peptide-1 receptor agonists (GLP1RA) for weight loss post-bariatric surgery. However, no systematic review and meta-analysis (SRM) till date has evaluated the efficacy, safety and tolerability of GLP1RA in this clinical scenario. Hence, this SRM aimed to address this knowledge gap.
METHODS
Databases were searched for randomized controlled trials (RCTs), case-control, cohort and observational studies involving use of GLP1RA in the intervention arm post-bariatric surgery. Primary outcome was weight loss post at least 3 months of therapy. Secondary outcomes were evaluation of body composition parameters, total adverse events (TAEs) and severe adverse events (SAEs).
RESULTS
From initially screened 1759 articles, 8 studies (557 individuals) were analysed. Compared to placebo, patients receiving liraglutide had significantly greater weight loss after 6-month therapy [MD - 6.0 kg (95% CI, - 8.66 to - 3.33); P < 0.001; I = 79%]. Compared to liraglutide, semaglutide had significantly greater percent reduction in body weight after 6-month [MD - 2.57% (95% CI, - 3.91 to - 1.23); P < 0.001; I = 0%] and 12-month [MD - 4.15% (95% CI, - 6.96 to - 1.34); P = 0.004] therapy. In study by Murvelashvili et al. (2023), after 12-month therapy, semaglutide had significantly higher rates of achieving > 15% [OR 2.15 (95% CI, 1.07-4.33); P = 0.03; n = 207] and > 10% [OR 2.10 (95% CI, 1.19-3.71); P = 0.01; n = 207] weight loss. A significant decrease in fat mass [MD - 4.78 kg (95% CI, - 7.11 to - 2.45); P < 0.001], lean mass [MD - 3.01 kg (95% CI, - 4.80 to - 1.22); P = 0.001] and whole-body bone mineral density [MD - 0.02 kg/m (95% CI, - 0.04 to - 0.00); P = 0.03] was noted with liraglutide.
CONCLUSION
Current data is encouraging regarding use of GLP1RAs for managing WG or IWL post-bariatric surgery. Deterioration of bone health and muscle mass remains a concern needing further evaluation.
TRIAL REGISTRATION
The predefined protocol has been registered in PROSPERO having registration number of CRD42023473991.
背景
大量肥胖症患者在接受减重手术后会出现体重增加（WG）或体重减轻不足（IWL）的问题。已经发表了多项研究评估了胰高血糖素样肽-1 受体激动剂（GLP1RA）在减重手术后减肥的作用。然而，迄今为止，尚无系统评价和荟萃分析（SRM）评估 GLP1RA 在这种临床情况下的疗效、安全性和耐受性。因此，本 SRM 旨在解决这一知识空白。
方法
数据库检索了涉及 GLP1RA 在减重手术后干预组中使用的随机对照试验（RCT）、病例对照、队列和观察性研究。主要结局是至少 3 个月治疗后体重减轻。次要结局是评估身体成分参数、总不良事件（TAEs）和严重不良事件（SAEs）。
结果
从最初筛选出的 1759 篇文章中，分析了 8 项研究（557 人）。与安慰剂相比，接受利拉鲁肽治疗的患者在 6 个月治疗后体重明显减轻[MD-6.0kg（95%CI，-8.66 至-3.33）；P<0.001；I=79%]。与利拉鲁肽相比，司美格鲁肽在 6 个月[MD-2.57%（95%CI，-3.91 至-1.23）；P<0.001；I=0%]和 12 个月[MD-4.15%（95%CI，-6.96 至-1.34）；P=0.004]治疗后体重百分比下降明显更大。在 Murvelashvili 等人的研究中。（2023），经过 12 个月的治疗，司美格鲁肽在达到>15%[OR 2.15（95%CI，1.07-4.33）；P=0.03；n=207]和>10%[OR 2.10（95%CI，1.19-3.71）；P=0.01；n=207]体重减轻的比例显著更高。脂肪量显著减少[MD-4.78kg（95%CI，-7.11 至-2.45）；P<0.001]、瘦体重[MD-3.01kg（95%CI，-4.80 至-1.22）；P=0.001]和全身骨矿物质密度[MD-0.02kg/m（95%CI，-0.04 至-0.00）；P=0.03]与利拉鲁肽有关。
结论
目前关于使用 GLP1RAs 治疗减重手术后 WG 或 IWL 的数据令人鼓舞。骨健康和肌肉质量的恶化仍然是一个需要进一步评估的问题。
试验注册
该预定义方案已在 PROSPERO 中注册，注册号为 CRD42023473991。
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